The Efficacy-Toxicity Conundrum: Breaking The Mold

Although the cure of advanced-stage Hodgkin lymphoma (HL) is a tremendous success, each new improvement in outcome has come with a significant price. Mechlorethamine, vincristine, procarbazine, and prednisone resulted in leukemia; doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) added possible fatal pulmonary toxicity; and bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) improved the cure but at a price of increased toxicity and increased leukemia. The ECHELON-1 study, reported by Straus et al in this issue of Blood, may be the first advance to break this pattern.